Provider Demographics
NPI:1801042494
Name:FAMILY HEALTH PREVENTION & CARE CENTER, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH PREVENTION & CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTUR
Authorized Official - Middle Name:G
Authorized Official - Last Name:DJAGARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-909-5153
Mailing Address - Street 1:333 E IL ROUTE 83
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4214
Mailing Address - Country:US
Mailing Address - Phone:847-566-0003
Mailing Address - Fax:847-566-5503
Practice Address - Street 1:333 E IL ROUTE 83
Practice Address - Street 2:SUITE 106
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4214
Practice Address - Country:US
Practice Address - Phone:847-566-0003
Practice Address - Fax:847-566-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL217092Medicare PIN